Experience in management of 51 non-functioning pituitary adenomas: Indications for post-operative radiotherapy

Abstract

Radiotherapy can be avoided in patients with complete macroscopic resection and absence of residual tumor in post-operative images; they must be carefully followed using imaging techniques and, in the case of recurrence, they should be re-operated and/or irradiated.

Factors predicting relapse of nonfunctioning pituitary macroadenomas after neurosurgery: a study of 142 patients

“…Unfortunately, no data on this mode of presentation were reported by Ferrante et al (5), who analyzed the large Italian database of NFPAs. It must be underlined that cavernous sinus invasion was more frequent in our patients (54%) than in previous series (33-52%) (6,7,12,27). This might be related to underestimation of invasive status in patients who did not undergo surgery or who were studied with older, less precise imaging procedures (CT rather than MRI); explanation could be also related to the definition of the invasive status.…”

“…However, even after complete or near complete surgical resection, NFMAs regrow in 12-58% of patients within 5 years (5)(6)(7)(8), and medical therapy with dopamine agonists or somatostatin analogs has a variable and often limited impact on the risk of recurrence (9). Some centers consider immediate postoperative radiation therapy in an attempt to prevent tumor regrowth (6,(10)(11)(12), but this approach carries a risk of complications such as hypopituitarism (13), cerebrovascular disease (14,15), potential neurocognitive dysfunction (16), and a low but welldocumented long-term risk of secondary intracranial tumors (17).…”

Volumetric Measurement for Comparison of the Accuracy between Intraoperative CT and Postoperative MR Imaging in Pituitary Adenoma Surgery

“…29,30 Although the GTR rate of large pituitary adenomas is approaching 50% in specialized centers, the results achieved in smaller surgical series seem less favorable, ranging from 14.3% to 43.1%. [31][32][33][34][35][36][37] In our patients, the GTR rate reached 89% (17/19) in the noninvasive and fresh cases (the 2 failed cases were giant adenomas) with aid of iCT. The overall GTR rate was 58% (19/33) in all our patients, and 62% (18/29) in the fresh cases, despite the preoperative tumor volume and invasiveness, which seems compatible with the previous results.…”

Surgical Indications and Results for Non-functioning Pituitary Adenomas

“…Other studies also found a similarly low rate of tumor recurrence when the first post-operative MRI showed no residual tumor. 19,32,33,35 In our large series, the five-year recurrence-free survival of such patients was 87.1%. 9 The use of prophylactic radiation therapy may not be warranted, provided that patients are willing to continue a tight follow-up with appropriate imaging studies.…”